A new systematic review of interventions for reducing pain and symptoms of depression in people living with arthritis, has found that combined mind-body based methods such as yoga, qigong and tai chi, were the most effective non-pharmacological approaches.

UNSW Sydney researchers analysed data from 23 international studies to identify effective non-pharmacological strategies for alleviating pain and symptoms. They compared single and multi-modal approaches with evidence-based treatment recommendations based on their findings.

The results, as published in Scientific Reports, indicate that while resistance/aerobic exercise or therapy alone did not improve depressive symptoms, mind-body approaches had greater improvements than aerobic/resistance exercise or therapy alone, for reducing pain and depression in people with osteoarthritis. 

Osteoarthritis is a chronic condition characterised by the progressive deterioration of protective cartilage that overlies the ends of bones in joints. It is associated with increased risk for other chronic conditions and is linked with reduced physical activity and stiffness, which can worsen pain symptoms and reduce quality of life. Depression and anxiety are both common psychological co-morbidities that occur alongside osteoarthritis in addition to other mental health conditions.

Treating without medication

Lead author and Postdoctoral Fellow Dr Claire Burley at the UNSW Medicine & Health Lifestyle Clinic and Centre for Healthy Brain Ageing (CHeBA), UNSW Medicine & Health, says effective non-pharmacological interventions are needed to address pain and depression in osteoarthritis, which are well-established risk factors for dementia, the leading cause of death in women and second leading cause of death following heart disease in all Australians.

“Given the strong correlation between osteoarthritis and dementia and that 40% of dementia cases could be prevented or delayed by targeting risk factors including physical inactivity and associated chronic conditions, our findings show promising non-pharmacological alternatives when mind-body approaches are combined,” says Dr Burley. 

Despite comprehensive research in this area, prior systematic reviews have not evaluated the most effective ways to manage pain levels and symptoms of depression in osteoarthritis, prompting this meta-analysis. 

“This is important because there is no cure for arthritis. Medications are often used to reduce pain but fundamentally they mask the symptoms and can have many negative effects on the person,” says Dr Burley.

“Our findings clearly demonstrated that movement meditation practices such as yoga, tai chi, and qigong had a more pronounced impact when compared to standalone aerobic or resistance exercise in reducing both pain and symptoms of depression,” says Dr Burley.

Furthermore, researchers found multimodal approaches such as combined physical activity with mind-based/education approaches, emerged as more effective than aerobic or resistance training alone, though still not as effective as the movement meditation methods. 

Prescribing exercise earlier

Exercise and education were also identified as key components of clinical guidelines for osteoarthritis management with the findings showing enhanced health outcomes for people who understand how to self-manage their pain and participate in regular physical activity. 

“Emphasising the importance of addressing psychological well-being, such as symptoms of depression, alongside physical health concerns like pain, is crucial for delivering high-quality healthcare to people living with osteoarthritis,” says A/Prof. Belinda Parmenter, study co-author and Head of UNSW Medicine & Health Lifestyle Clinic.  

The researchers cite tailored interventions using a collaborative and holistic approach involving healthcare professionals from diverse disciplines, including nutrition, exercise, psychology, as well as actively engaging with patients/clients, for successful best practice outcomes. 

“We need to encourage people to take part in mind-body based approaches, rather than taking medications. Educating health professionals on more effective approaches that they can provide for their clients/patients’ needs to be a priority,” says A/Prof. Parmenter. 

“These approaches are accessible to everyone, and they can be modified for different populations.”

Study significance

Given the high prevalence rates and co-existing conditions, qualitative studies like focus groups and interviews with people living with osteoarthritis and depression, can significantly improve understanding of these conditions for developing targeted treatment options. 

“We have just received a small seed grant to run a pilot Healthy Body & Mind Program for people living with cognitive decline and osteoarthritis, so the findings from this research will inform that program,” says Dr Burley.

“We are collaborating with people living with dementia to develop the program and have several students who are also developing interventions for people living with osteoarthritis and other chronic conditions such as diabetes and osteoporosis. Additionally, we are examining the effects of diet on chronic conditions.”